Abstract
Purpose Many patients with persistent incontinence after an artificial urinary sphincter procedure gain improved continence after cuff downsizing. In 2010 a new, smaller (3.5 cm) artificial urinary sphincter cuff was introduced. We hypothesized that men with spongiosal atrophy previously treated with a 4.0 cm cuff would now show a decreased rate of revision surgery due to more accurate cuff sizing. Materials and Methods We evaluated the outcome in men who received identical 4.0 cm cuff sizes in 2 eras, before (2007 to 2009) and after (2010 to 2013) the introduction of the 3.5 cm artificial urinary sphincter cuff. Patients with a history of cuff erosion or those undergoing tandem, transcorporal, or 4.5 cm or greater cuff placement were excluded from analysis. We validated our institutional results using the nationwide AMS® PIF (Patient Information Form) database from identical time frames. Results Of 236 men who underwent artificial urinary sphincter placement at our institution during the study period 170 with a mean age of 67 years met study inclusion criteria, of whom 88 (52%) received a 4.0 cm artificial urinary sphincter cuff. Mean followup was 34 months. Ten of 45 patients (22.2%) who had a 4.0 cm cuff placed from 2007 to 2009 required cuff downsizing for persistent incontinence while only 2 of 43 (4.7%) who received a 4.0 cm cuff from 2010 to 2013 required revision (p <0.001). Nationally patients with a 4.0 cm cuff underwent fewer revisions during the latter era (16.2% vs 7.5%, p = 0.001). In local and national cohorts Kaplan-Meier analysis revealed improved survival of the 4.0 cm cuff after the introduction of the 3.5 cm cuff (p <0.05). Conclusions The incidence of artificial urinary sphincter revision surgery in patients with a 4.0 cm cuff has decreased since the availability of the 3.5 cm cuff. This suggests that precise cuff sizing appears to be beneficial in men with spongiosal atrophy.
Original language | English |
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Pages (from-to) | 798-803 |
Number of pages | 6 |
Journal | Journal of Urology |
Volume | 192 |
Issue number | 3 |
DOIs | |
State | Published - Sep 2014 |
Keywords
- Adult
- Aged
- Aged, 80 and over
- Atrophy
- Dimensional Measurement Accuracy
- Humans
- Male
- Middle Aged
- Prosthesis Design
- Prosthesis Fitting
- Reoperation/statistics & numerical data
- Retrospective Studies
- Urethra/pathology
- Urinary Incontinence, Stress/surgery
- Urinary Sphincter, Artificial
- Young Adult